LOOK ALIKE - DR. RAJESH KANNAN

Summary

In this medical case presentation, a 40-year-old female presents with two months of dry cough and progressive dyspnea, alongside critical vital signs indicating possible shock. Initial examinations suggest potential pulmonary tuberculosis or chronic heart failure, but imaging reveals a mass likely indicative of primary lung malignancy. Further investigation leads to a diagnosis of granulomatosis with polyangiitis (GPA), confirmed through biopsy. The patient, experiencing complications like nasal bleeding and sensory neural hearing loss, is treated with steroids and immunosuppressants. This case highlights the complexities of differential diagnosis in respiratory conditions and the importance of thorough investigation.

Takeaways

• 😀 A 40-year-old female presented with dry cough and progressive dyspnea for two months, without significant prior medical history.
• 😷 Initial examination revealed vital signs indicating severe hypotension and respiratory distress.
• 🩺 Differential diagnoses considered included pulmonary tuberculosis, chronic heart failure, and interstitial lung disease.
• 📉 The patient's blood pressure was critically low at 70/50, prompting immediate medical intervention.
• 🔬 Diagnostic imaging revealed a large tissue density lesion in the right hilar region, suggestive of primary lung malignancy.
• 🔍 CT-guided biopsy results indicated granulomatous inflammation consistent with granulomatosis with polyangiitis (GPA).
• 💉 The patient's initial treatment involved antibiotic therapy due to suspected infection, followed by corticosteroids and cyclophosphamide.
• 👩‍⚕️ The clinical presentation included nasal bleeding and hearing loss, further indicating progression of the underlying condition.
• 🧠 GPA was diagnosed as the final diagnosis, based on imaging and biopsy results, with limited lung involvement.
• ❓ The case highlights the importance of thorough diagnostic processes in distinguishing between malignancies and autoimmune conditions.

Q & A

What are the primary symptoms presented by the patient?

The patient presented with a dry cough for the past two months and progressive dyspnea during the same period.

What were the significant findings during the patient's examination?

Notable findings included a heart rate of 80 bpm, respiratory rate of 22 breaths/min, blood pressure of 70/50 mmHg, and decreased breath sounds in the right lung field.

What were the differential diagnoses considered for the patient?

The differential diagnoses included pulmonary tuberculosis, chronic heart failure, and interstitial lung disease.

What diagnostic tests were conducted, and what were their results?

A GJ aspirate was performed and came back negative. The CRP level was elevated at 181, indicating inflammation, while the CT thorax revealed a large tissue density lesion in the right hilar region suggestive of primary lung malignancy.

What was the final diagnosis made after the biopsy?

The final diagnosis was Granulomatosis with Polyangiitis (GPA), limited to lung involvement, confirmed by the positive anti-PR3 antibody test and findings from the CT-guided biopsy.

How was the patient managed initially upon admission?

The patient received ionotropic support and antibiotics due to low blood pressure, followed by the initiation of steroids and cyclophosphamide after stabilization.

What improvement was noted in the patient's condition after treatment?

The patient's CRP levels improved, decreasing from 181 to 35, indicating a positive response to treatment.

What new symptoms developed during the follow-up?

During follow-up, the patient developed nasal bleeding, crusting, and sensory neural hearing loss.

Why was pulmonary tuberculosis initially considered in the differential diagnoses?

Pulmonary tuberculosis was considered due to the patient’s prolonged cough and the absence of significant weight loss or fever, which could suggest a chronic infection.

What is the significance of the CT-guided biopsy in this case?

The CT-guided biopsy was crucial for determining the nature of the lesion and provided evidence of granulomatous inflammation, which was consistent with the diagnosis of GPA.